Welcome to the Cognitive Development Lab

Participation Form

Only parents or legal guardians should fill out this form. We will contact you within 5 business days. The IU Cognitive Develoment Lab respects and protects the privacy of the information you submit to us.

Child's full name:
Last:
First:
Middle Initial:

Please indicate gender:
male
female

Child's birthdate:(ex: 03/01/00)

Parent's names:
Mother Last:
First:

Father Last:
First:

Street address:

City: State: (ex: IN)Zip code:

Home phone number: (ex: 812-555-5555)

Cell phone number: (ex: 812-555-5555)

Work phone number: (optional)

E-mail address:(ex: johndoe@indiana.edu)

Is this your child's first visit to theCognitive Development Lab?
no
yes

Does this child have siblings under 6 years of agewho would also like to participate?
yes
no